Clinical Quality Assurance Nurse Auditor

Requisition ID

2018-2531

# of Openings

1

Category

Operations

Location

US-CA-Redding

Overview

The Clinical Quality Assurance Nurse Auditor is responsible for evaluating clinical information received from various healthcare providers and writes various reports based on the clinical information received. This position ensures reports are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates. This position is required to handle quality assurance questions and provide overall support to the Quality Assurance Department.

This position will require two days in the Redding office and allows you to work from home three days per week!

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.

Ensures that all client instructions and specifications have been followed and that all questions have been addressed.

Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.

Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.

In IME or Peer Review cases, ensures the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.

Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.

Ensures the provider credentials and signature are adhered to the final report.

Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.